Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases (2024)

Gamaletsou, M. N., Rammaert, B., Bueno, M. A., Sipsas, N. V., Moriyama, B., Kontoyiannis, D. P., Roilides, E., Zeller, V., Taj-Aldeen, S. J., Henry, M., Petraitis, V., Denning, D. W., Lortholary, O., Walsh, T. J., & International Osteoarticular Mycoses Consortium (2016). Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases. Medical Mycology. https://doi.org/10.1093/mmy/myw077

Gamaletsou, Maria N ; Rammaert, Blandine ; Bueno, Marimelle A et al. / Aspergillus arthritis : analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases. In: Medical Mycology. 2016.

@article{adeeaf1a955d4579b0be7ca65cf1417c,

title = "Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases",

abstract = "Aspergillus arthritis is a debilitating form of invasive aspergillosis. Little is known about its epidemiology, clinical manifestations, laboratory features, treatment, and prognosis. Cases of Aspergillus arthritis were reviewed in the English literature from 1967 through 2015 for variables of arthritis with Aspergillus spp. recovered from joint and/or adjacent bone, underlying conditions, symptoms, signs, inflammatory biomarkers, diagnostic imaging, management, and outcome. Among 31 evaluable cases, 87% were males and 13% pediatric. Median age was 50 y (range 1-83 y). Seventeen (55%) patients were immunosuppressed with such conditions as hematological malignancies (26%), corticosteroids (39%), and/or transplantation (26%). Approximately one-half (52%) of patients had hematogenous seeding of the joint, and more than 80% had de novo infection with no prior antifungal therapy. Oligoarticular infection (2-3 joints) occurred in 45% and contiguous osteomyelitis was present in 61%. Clinical manifestations included pain (87%), edema (26%), and limited function (23%), with knees (35%), intervertebral discs (26%), and hips (16%) being most commonly infected. Aspergillus fumigatus constituted 77% of cases followed by Aspergillus flavus in 13%, Aspergillus niger in 3%, and not specified in 7%. Median ESR was 90 mm/hr and median CRP was 3.6 mg/dl. Median synovial fluid WBC was 17,200/μL (7,300-128,000) with 72% PMNs (range 61-92). Osteolysis occurred in 35%, and soft-tissue extension 47%. Nineteen patients (61%) were managed with combined medical and surgical therapy, 10 (32%) with medical therapy only, and 2 (6%) surgery only. Amphotericin B and itraconazole were the most frequently used agents with median duration of therapy of 219 days (range 30-545). Surgical interventions included debridement in 61%, drainage 19%, and amputation 6%. Complete or partial response was achieved in 71% and relapse occurred in 16%. Medical therapy was reinstituted with successful outcome in these patients. Overall survival was 65%. Aspergillus arthritis mainly develops as a de novo infection involving knees and intervertebral disks in immunocompromised patients with localizing symptoms. Contiguous osteomyelitis is frequently observed. Diagnosis is established by synovial fluid culture. Aspergillus arthritis is therapeutically challenging with most patients undergoing surgery and protracted antifungal therapy.",

author = "Gamaletsou, {Maria N} and Blandine Rammaert and Bueno, {Marimelle A} and Sipsas, {Nikolaos V} and Brad Moriyama and Kontoyiannis, {Dimitrios P} and Emmanuel Roilides and Valerie Zeller and Taj-Aldeen, {Saad J} and Michael Henry and Vidmantas Petraitis and Denning, {David W} and Olivier Lortholary and Walsh, {Thomas J} and {International Osteoarticular Mycoses Consortium}",

note = "Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.",

year = "2016",

doi = "10.1093/mmy/myw077",

language = "English",

journal = "Medical Mycology",

issn = "1369-3786",

publisher = "Informa Healthcare",

}

Gamaletsou, MN, Rammaert, B, Bueno, MA, Sipsas, NV, Moriyama, B, Kontoyiannis, DP, Roilides, E, Zeller, V, Taj-Aldeen, SJ, Henry, M, Petraitis, V, Denning, DW, Lortholary, O, Walsh, TJ & International Osteoarticular Mycoses Consortium 2016, 'Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases', Medical Mycology. https://doi.org/10.1093/mmy/myw077

Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases. / Gamaletsou, Maria N; Rammaert, Blandine; Bueno, Marimelle A et al.
In: Medical Mycology, 2016.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Aspergillus arthritis

T2 - analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases

AU - Gamaletsou, Maria N

AU - Rammaert, Blandine

AU - Bueno, Marimelle A

AU - Sipsas, Nikolaos V

AU - Moriyama, Brad

AU - Kontoyiannis, Dimitrios P

AU - Roilides, Emmanuel

AU - Zeller, Valerie

AU - Taj-Aldeen, Saad J

AU - Henry, Michael

AU - Petraitis, Vidmantas

AU - Denning, David W

AU - Lortholary, Olivier

AU - Walsh, Thomas J

AU - International Osteoarticular Mycoses Consortium

N1 - Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

PY - 2016

Y1 - 2016

N2 - Aspergillus arthritis is a debilitating form of invasive aspergillosis. Little is known about its epidemiology, clinical manifestations, laboratory features, treatment, and prognosis. Cases of Aspergillus arthritis were reviewed in the English literature from 1967 through 2015 for variables of arthritis with Aspergillus spp. recovered from joint and/or adjacent bone, underlying conditions, symptoms, signs, inflammatory biomarkers, diagnostic imaging, management, and outcome. Among 31 evaluable cases, 87% were males and 13% pediatric. Median age was 50 y (range 1-83 y). Seventeen (55%) patients were immunosuppressed with such conditions as hematological malignancies (26%), corticosteroids (39%), and/or transplantation (26%). Approximately one-half (52%) of patients had hematogenous seeding of the joint, and more than 80% had de novo infection with no prior antifungal therapy. Oligoarticular infection (2-3 joints) occurred in 45% and contiguous osteomyelitis was present in 61%. Clinical manifestations included pain (87%), edema (26%), and limited function (23%), with knees (35%), intervertebral discs (26%), and hips (16%) being most commonly infected. Aspergillus fumigatus constituted 77% of cases followed by Aspergillus flavus in 13%, Aspergillus niger in 3%, and not specified in 7%. Median ESR was 90 mm/hr and median CRP was 3.6 mg/dl. Median synovial fluid WBC was 17,200/μL (7,300-128,000) with 72% PMNs (range 61-92). Osteolysis occurred in 35%, and soft-tissue extension 47%. Nineteen patients (61%) were managed with combined medical and surgical therapy, 10 (32%) with medical therapy only, and 2 (6%) surgery only. Amphotericin B and itraconazole were the most frequently used agents with median duration of therapy of 219 days (range 30-545). Surgical interventions included debridement in 61%, drainage 19%, and amputation 6%. Complete or partial response was achieved in 71% and relapse occurred in 16%. Medical therapy was reinstituted with successful outcome in these patients. Overall survival was 65%. Aspergillus arthritis mainly develops as a de novo infection involving knees and intervertebral disks in immunocompromised patients with localizing symptoms. Contiguous osteomyelitis is frequently observed. Diagnosis is established by synovial fluid culture. Aspergillus arthritis is therapeutically challenging with most patients undergoing surgery and protracted antifungal therapy.

AB - Aspergillus arthritis is a debilitating form of invasive aspergillosis. Little is known about its epidemiology, clinical manifestations, laboratory features, treatment, and prognosis. Cases of Aspergillus arthritis were reviewed in the English literature from 1967 through 2015 for variables of arthritis with Aspergillus spp. recovered from joint and/or adjacent bone, underlying conditions, symptoms, signs, inflammatory biomarkers, diagnostic imaging, management, and outcome. Among 31 evaluable cases, 87% were males and 13% pediatric. Median age was 50 y (range 1-83 y). Seventeen (55%) patients were immunosuppressed with such conditions as hematological malignancies (26%), corticosteroids (39%), and/or transplantation (26%). Approximately one-half (52%) of patients had hematogenous seeding of the joint, and more than 80% had de novo infection with no prior antifungal therapy. Oligoarticular infection (2-3 joints) occurred in 45% and contiguous osteomyelitis was present in 61%. Clinical manifestations included pain (87%), edema (26%), and limited function (23%), with knees (35%), intervertebral discs (26%), and hips (16%) being most commonly infected. Aspergillus fumigatus constituted 77% of cases followed by Aspergillus flavus in 13%, Aspergillus niger in 3%, and not specified in 7%. Median ESR was 90 mm/hr and median CRP was 3.6 mg/dl. Median synovial fluid WBC was 17,200/μL (7,300-128,000) with 72% PMNs (range 61-92). Osteolysis occurred in 35%, and soft-tissue extension 47%. Nineteen patients (61%) were managed with combined medical and surgical therapy, 10 (32%) with medical therapy only, and 2 (6%) surgery only. Amphotericin B and itraconazole were the most frequently used agents with median duration of therapy of 219 days (range 30-545). Surgical interventions included debridement in 61%, drainage 19%, and amputation 6%. Complete or partial response was achieved in 71% and relapse occurred in 16%. Medical therapy was reinstituted with successful outcome in these patients. Overall survival was 65%. Aspergillus arthritis mainly develops as a de novo infection involving knees and intervertebral disks in immunocompromised patients with localizing symptoms. Contiguous osteomyelitis is frequently observed. Diagnosis is established by synovial fluid culture. Aspergillus arthritis is therapeutically challenging with most patients undergoing surgery and protracted antifungal therapy.

U2 - 10.1093/mmy/myw077

DO - 10.1093/mmy/myw077

M3 - Article

C2 - 27609563

SN - 1369-3786

JO - Medical Mycology

JF - Medical Mycology

ER -

Gamaletsou MN, Rammaert B, Bueno MA, Sipsas NV, Moriyama B, Kontoyiannis DP et al. Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases. Medical Mycology. 2016. Epub 2016 Sept 8. doi: 10.1093/mmy/myw077